Frequently Asked Questions

• Treatment at Hearthstone Psychiatry and Wellness is voluntary. Services may include diagnostic assessment, psychotherapy, medication management, coordination with other clinicians, and laboratory monitoring when clinically indicated
• Psychiatric medications can be highly effective, but they may also carry risks. Possible side effects vary depending on the medication and may include metabolic changes, sedation, movement disorders, cardiovascular effects, mood changes, or rare but serious adverse reactions. All side effects for every medication cannot be discussed in the limited time of an appointment, but most common and/or most concerning reactions to each medication will be discussed. If any other concerns arise, you are always welcome to ask further questions about treatment options proposed. Alternatives, including non-medication treatment or no treatment, will be discussed. 
• Confidentiality is fundamental to psychiatric care. However, Tennessee law requires disclosure in certain situations, including suspected abuse or neglect, court orders, or credible threats of serious harm to yourself or others.
• You may always withdraw your consent for treatment or terminate your treatment at Hearthstone Psychiatry and Wellness at any time.

• Telehealth services use secure electronic communication technologies. While telehealth increases access and convenience, potential risks include technical difficulties or rare privacy breaches.
• You must provide your physical location at each telehealth visit. In the event of an emergency, local emergency services may be contacted.
• You are expected to be in a private, quiet location within the state of Tennessee for telehealth services. If the location is not suitable to provide adequate care or privacy, your appointment may be terminated, and you may still be charged a fee matching the no-show fee policy for the appointment.
• You may request in-person services when clinically appropriate and available.

• Patients may communicate with our office through the secure patient portal or by calling the office.
• Routine messages will receive a response within two (2) business days (excluding weekends and holidays).
• Medication refill requests require three (3) business days
• The patient portal and voicemail are not monitored continuously and are not appropriate for emergencies. See Crisis Policy for emergency resources.

Hearthstone Psychiatry & Wellness does not provide after-hours emergency coverage.

If you are experiencing a psychiatric emergency — including active suicidal thoughts with intent, homicidal thoughts, severe medication reactions, or inability to maintain your safety — seek immediate help:

• Dial 911 (Emergency services)
• Dial 988 (Suicide & Crisis Lifeline)
• Present to a local hospital Emergency Room or one of the following local crisis resources:

• Woodridge Hospital (Ballad Health) – 403 N State of Franklin Rd, Johnson City, TN 37604 – (423) 431-7111 – Walk -in crisis assessment center open 24/7
• Frontier Health – Turning Point CSU – 208 E Unaka Ave, Johnson City, TN 37601 – (423) 926- 0940 – 24/7
• Frontier Health Mobile Crisis Hotline – (877) 928-9062 – 24/7
• Creekside Behavioral Health – 1025 Executive Park Blvd, Kingsport, TN 37660 (888) 252- 2154

Please be aware that if our clinic staff have reason to suspect that anyone in the clinic or in communication with the clinic may be a harm to themselves or others, the following may occur in accordance with state law:

• 911 may be contacted
• You may be required to remain in the clinic until emergency services arrives to transport you to the hospital
• Emergency services may arrive for a welfare check at your location if you are not in the clinic.

• Payment is due at the time of service unless prior arrangements have been made. Copays, deductibles, and self-pay fees are the responsibility of the patient.
• Appointments must be cancelled at least 24 hours in advance. Late cancellations or missed appointments may result in a fee. This policy helps ensure availability for other patients in need.
• Medication refill requests require three (3) business days. Please plan accordingly.
• If you are uninsured or self-pay, you will receive a Good Faith Estimate in accordance with the federal No Surprises Act.

New patient assessment cash

• Cash pay estimate: $350
• Please note that this fee is for an assumed average of 60 minutes for a new patient evaluation. If the assessment requires more time than this, the fee may increase accordingly with an average fee of $88 per 15-minute interval

Follow up assessment

• Cash pay estimate: $175
• Please note that this fee is for an assumed average of 0 minutes for a follow-up evaluation. If the assessment requires more time than this, the fee may increase accordingly with an average fee of $88 per 15-minute interval

In the event of a cancellation with notice greater than 24 hours, there will be no fee for cancellation or rescheduling.

In the event of a cancellation with notice less than 24 hours the following fees may be incurred:

• 1st occurrence: $25
• 2nd occurrence: $50
• 3rd or greater occurrence: $100
• At any point, the clinic may consider termination of care due to breach of appropriate treatment adherence
• Exceptions may be made on a case-by-case basis at the determination of the clinic, at which time the fee may either be waived, refunded to payment, or refunded as a credit to future appointments.

In the event of a patient not showing to (or missing) an appointment:

• 1st occurrence: $75
• 2nd or greater occurrence: $150
• At any point, the clinic may consider termination of care due to breach of appropriate treatment adherence
• Exceptions may be made on a case-by-case basis at the determination of the clinic, at which time the fee may either be waived, refunded to payment, or refunded as a credit to future appointments

• Controlled substances will only be prescribed if deemed medically appropriate by your clinician. Your clinician has the right to reduce or refuse to prescribe medication as is deemed appropriate at any time. 
• If controlled substances are prescribed, you agree to use one designated pharmacy and comply with Tennessee Controlled Substance Monitoring Database (CSMD) checks
• Early refills or replacement prescriptions for lost or stolen medication may not be granted
• Random urine drug screening may be required to ensure safe prescribing
• Failure to comply with this policy may result in modification or discontinuation of controlled substance prescribing

• Certain medications require periodic laboratory testing (for example, lithium, valproate, or antipsychotics)
• Completion of recommended laboratory monitoring is a condition of ongoing prescribing

• Hearthstone Psychiatry & Wellness may use secure, HIPAA-compliant AI-assisted documentation tools during clinical visits.
• These tools are designed to assist your clinician in creating accurate and efficient clinical notes. The AI tool may process spoken conversation during your visit for the sole purpose of generating a draft clinical note for your clinician’s review.
• The AI tool does not independently diagnose, prescribe, or make clinical decisions
• All documentation is reviewed, edited, and finalized by your treating clinician
• The AI tool functions only as a documentation support aid
• The tool is used solely for healthcare treatment and healthcare operations purposes
• The AI vendor is required to comply with HIPAA privacy and security standards. Any information processed by the system is encrypted and handled in accordance with healthcare privacy regulations
• Your information is not sold or used for marketing purposes, nor is it used for training AI systems
• Your information is solely used for the purpose of generating clinical documentation for your medical record
• Use of this technology allows your clinician to spend less time typing and more time focused on listening and engaging with you during your appointment. All clinical decisions and documentation remain the responsibility of your treating clinician.
• By receiving care at Hearthstone Psychiatry & Wellness, you acknowledge that AI-assisted documentation tools may be used as part of the clinical documentation process, but that your clinician remains fully responsible for the accuracy and content of your medical record.

• Treatment may be discontinued for repeated missed appointments, non-payment, non-adherence to treatment recommendations, or inappropriate behavior toward others. This includes yelling/cursing, physically threatening others, or any other behavior that causes others to feel unsafe. Under no circumstances will this be tolerated for any reason.
• If a patient is discharged from the clinic, except in urgent circumstances, reasonable notice and referral information will be provided to support continuity of care.

We do not perform disability assessments and are not able to fill out paperwork for disability claims. You may request your medical records in accordance with state and national laws to support an ongoing disability claim at your request for a fee of $25 for up to 5 pages then $0.50 for each page thereafter.

You may request your medical records at any time. Per state and federal laws, we will provide you with medical records within ten (10) business days. Medical records will incur a fee of $25 for up to 5 pages then $0.50 for each page thereafter.

Note that only you have the right to request your medical records unless:

• You sign a release of information for the person or entity the records are being released to
• You become incapacitated and have a designated power of attorney for healthcare or healthcare proxy
• You are a minor and/or require a conservator
• Release of records is allowed under the Health Insurance Portability and Accountability Act (HIPAA) for treatment, payment, or operations related to your care
• A warrant, subpoena, or court order is received requiring the release of medical records
• If you are seeking the records of a patient who is now deceased, you will be required to provide a copy of the death certificate, proof of legal authority over the records (Letters testamentary or other court order appointing you as personal representative, administrator, or executor of the estate), and proof of your identity with two(2) forms of identification. You will also be asked to sign a release of information form for the deceased individual’s medical records to be released to you. 

A work or school excuse may be provided at your request for a scheduled visit, however excuses for time off not directly related to a scheduled visit is at the discretion of the clinician and may incur a fee of $5 per page.

Family and Medical Leave Act (FMLA) paperwork may be filled out at the clinician’s discretion if the leave is related to conditions related to your care at Hearthstone Psychiatry and Wellness or treatment related to these conditions. FMLA paperwork may incur a fee of $50 for up to 5 pages then $0.50 per page thereafter.

We are unable to provide emotional support animal (ESA) letters. In rare circumstances for patients who are established and have a long-standing relationship with a provider, exceptions may be made. Please be aware that if this exception is made, our providers will only be able to provide the written letter in support of your ESA. ESA letters will incur a fee of $100 per page.

Any other paperwork requests will be at the discretion of your clinician and may incur a fee of up to $100 per page.